The Status of Diabetic Retinopathy and Diabetic Macular Edema in Patients with Type 2 Diabetes: A Survey from Beixinjing District of Shanghai City in China

Wang, Ning; Xu, Xun; Zou, Haidong; Zhu, Jianfeng; Wang, Weiwei; Ho, Pak‐Chung

doi:10.1159/000109276

Cited by 33 publications

(23 citation statements)

References 19 publications

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“…Around 5% of type II diabetes patients had DME when diabetes was diagnosed, gradually increasing to 30% within 25–30 years. A Chinese population-based epidemiological study reported that the prevalence of DME in type II diabetes was 5.89% [9], while it was 4.3% in Beijing metropolitan areas [10] and 5.2% in rural areas [11]. …”

Section: Epidemiology Of Dmementioning

confidence: 99%

Diabetic macular edema: new concepts in patho-physiology and treatment

et al. 2014

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Diabetic macular edema (DME), a serious eye complication caused primarily by hyperglycemia, is one of the major causes of blindness. DME, which is characterized by cystic retinal thickening or lipid deposition, is prone to relapse after successful treatment. DME is a complex pathological process caused by multiple factors, including breakdown of the inner and outer blood-retinal barriers, oxidative stress, and elevated levels of vascular endothelial growth factor which have been demonstrated in both preclinical and clinical studies. Starling’s law theory explains many of the features of DME. Early detection and treatment of DME can prevent vision loss. Current effective interventions for DME include treatment of systemic risk factors, such as elevated blood glucose, blood pressure and dyslipidemia. Ophthalmic treatments include laser photocoagulation, surgery and intraocular pharmacotherapy. New drugs, which are given by intraocular injection, have emerged in recent years to become first line treatment for DME that affects the central macula with loss of vision. Laser photocoagulation is still the gold standard of treatment for DME which does not involve the central macular. This review outlines these new treatments with particular emphasis on the optimal timing of how they are given.

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Section: Epidemiology Of Dmementioning

confidence: 99%

Diabetic macular edema: new concepts in patho-physiology and treatment

et al. 2014

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“…4,5 With economic development and life improvement, the diabetic population is estimated to be 92.4 million in adults in China, 6 and at least 20% may have complications such as DR. 7,8 DR is a microvascular complication that develops in more than 75% of patients with a 20-year duration of type II diabetes and in all patients with type I diabetes. 2 Annual fundus screening and timely intervention by laser therapy in patients with diabetes is the standard of care to prevent visual impairment and blindness from DR. [9][10][11] The bulk of the evidence shows that prompt panretinal photocoagulation (PRP) and focal (direct or grid) laser treatment reduced the risk for severe visual loss compared with deferral of treatment over the long term.…”

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confidence: 99%

Analysis of reasons for noncompliance with laser treatment in patients of diabetic retinopathy

Hua

Cao

Cui

et al. 2017

Canadian Journal of Ophthalmology

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Objective-To identify the underlying reasons for noncompliance among Chinese patients undergoing laser photocoagulation treatment for diabetic retinopathy (DR). Design-Prospective cohort study.Participants-A total of 262 patients with DR with indications for panretinal photocoagulation and focal laser treatment were recruited.Methods-Those who did not complete the prescribed laser treatment were categorized into 2 types of defaulters: Type 1 defaulters were those who did not initiate laser treatment as scheduled; type 2 defaulters were those who did not complete the entire laser sessions, including terminating midterm or defaulting prompt supplement of laser treatment. A standardized questionnaire was given to the 2 types of defaulters to collect information about the reasons for noncompliance. Data were analyzed and subjected to χ 2 test or Fisher exact statistical tests.Results-The noncompliance rate was 45.5%, which is significantly greater than some developed countries. Unawareness of the necessity for treatment and unawareness of the importance to complete treatment were 2 main reasons leading to noncompliance, representing 28.8% and 36.0%, respectively. Unawareness of the necessity for treatment and fear of laser treatment were more important for type 1 defaulters (29 vs 6 and 11 vs 0, respectively), whereas unawareness of completeness of laser treatment was overweighed in type 2 defaulters (27 vs 13 patients; all P < 0.01). These results were likely related to the lack of knowledge about the potential consequences of DR, the underlying principle of laser treatment, and panretinal photocoagulation procedures.Conclusions-Developing appropriate education programs targeting specific reasons will help to improve the compliance in patients with DR. The bulk of the evidence shows that prompt panretinal photocoagulation (PRP) and focal (direct or grid) laser treatment reduced the risk for severe visual loss compared with deferral of treatment over the long term. [12][13][14][15][16][17] Several studies in the United States have shown that many patients with diabetes fail to seek or receive dilated eye examination and timely treatment according to guidelines, and the average compliance rate may vary from approximately 30% to 60%. 18-20 A variety of factors contributed to the high noncompliance rate, such as transport, absence of a decision maker, fear of laser treatment, socioeconomic barriers, health system barriers, educational barriers, and cultural barriers. [21][22][23] According to our clinical experience, the same issues occurred in Chinese patients with diabetes, but the underlying factors were unclear. Moreover, many patients defaulted from the laser treatment in progress, although many reports showed that the supplementary laser photocoagulation and the subsequent follow-up were as important as the initial laser sessions. [24][25][26] The literature shows the value of educational programs in improving patient adherence to guidelines when the programs targeted specific reasons behind the noncompli...

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“…17 An epidemiologic study in the Shanghai city region in China assessing 108,132 residents identified 829 patients with diabetes older than 15 years, of whom 36 (4.34%) had macular edema. 18 In the Singapore Malay study, which included 3261 patients with diabetes, the overall prevalence of macular edema was 5.7%. 19 The overall prevalence of DME in Asian patients with diabetes is comparable with that seen in the United States and European countries (0.85%e12.3%).…”

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confidence: 99%